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Assessing use of patient-focused pharmacotherapy in glycemic management through the Diabetes Collaborative Registry (DCR).
- Source :
-
Journal of diabetes and its complications [J Diabetes Complications] 2018 Nov; Vol. 32 (11), pp. 1035-1039. Date of Electronic Publication: 2018 Aug 09. - Publication Year :
- 2018
-
Abstract
- Background: Although practice guidelines stress individualization of glucose management in patients with type 2 diabetes (T2D), the extent to which providers take patient factors into account when selecting medications is not well known.<br />Methods: Diabetes Collaborative Registry (DCR) is an outpatient diabetes registry including primary care, cardiology, and endocrinology practices. T2D medications were grouped as those which may be suboptimal for key patient subgroups, and we examined patient factors associated with use of these agents using hierarchical, multivariable Poisson models.<br />Results: In DCR, 157,551 patients from 374 US practices were prescribed a glucose-lowering medication. Patients with morbid obesity were more likely treated with medications prone to cause weight gain (relative rate [RR] 1.09, 95% CI 1.07-1.11). Older patients were more likely to be treated with medications with increased risk of hypoglycemia (RR 1.04 per 5 years, 95% CI 1.04-1.05). Patients with CKD 4/5 were less likely to be treated with agents with known risk in patients with advanced CKD (RR 0.74, 95% CI 0.71-0.77). Patients with coronary artery disease were no more or less likely to be treated with medications with potential cardiovascular safety issues (RR 0.99, 95% CI 0.96-1.01).<br />Conclusions: We observed some targeted use of glucose-lowering therapies in certain subgroups but also identified potential opportunities for better personalization of treatment. Data sources such as the DCR can highlight potential areas for improving targeted approaches to pharmacologic therapy in order to optimize selection of patients most likely to benefit (and least likely to be harmed) from treatments.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Cohort Studies
Cooperative Behavior
Diabetes Mellitus, Type 2 epidemiology
Female
Humans
Male
Middle Aged
Practice Patterns, Physicians' standards
Precision Medicine methods
Quality Improvement
Registries
United States epidemiology
Diabetes Mellitus, Type 2 drug therapy
Drug Utilization standards
Drug Utilization statistics & numerical data
Hypoglycemic Agents therapeutic use
Practice Patterns, Physicians' statistics & numerical data
Precision Medicine statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1873-460X
- Volume :
- 32
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Journal of diabetes and its complications
- Publication Type :
- Academic Journal
- Accession number :
- 30177468
- Full Text :
- https://doi.org/10.1016/j.jdiacomp.2018.02.009